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In Reply: Dr Alevizos and colleagues suggest that the association of psoriasis and MI that we observed may be due to psoriasis-associated depression. Although this possibility requires further research to fully address, confounding by depression is unlikely to explain our results.

First, the prevalence of severe depression in patients with psoriasis and the magnitude of this potential association have not been well established in large, broadly representative population-based studies. The authors refer to a small, specialty clinic–based study that demonstrated that patients hospitalized for psoriasis were more likely to be depressed, based on Beck Depression Inventory scores (mean score in mild-moderate depression range), compared with healthy controls.¹ The correlation between depression scores and psoriasis severity was weak (r = 0.29) and it is unclear if these results would generalize to the broader population of patients with psoriasis we studied. Alevizos et al also refer to 1 large study of patients . . . [Full Text of this Article]

Joel M. Gelfand, MD, MSCE
joel.gelfand@uphs.upenn.edu
Department of Dermatology
University of Pennsylvania
Philadelphia

Shanu Kohli Kurd, MHS
Jefferson Medical College
Philadelphia, Pa

Andrea L. Neimann, MD
Department of Dermatology
Albert Einstein School of Medicine
New York, NY

Daniel B. Shin, BA; David J. Margolis, MD, PhD
Department of Dermatology
University of Pennsylvania

Andrea B. Troxel, ScD
Center for Clinical Epidemiology and Biostatistics
University of Pennsylvania

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